Introduction Hypoestrogenism causes structural changes in the vaginal wall that can lead to sexual dysfunction. A reduction in vaginal wall thickness has been reported to occur after menopause, although without precise morphometry. Aim To measure vaginal wall thickness in women with genital prolapse in normal and hypoestrogenic conditions and to correlate sexual dysfunction with vaginal wall thickness and estradiol levels. Methods Surgical vaginal specimens from 18 normoestrogenic and 13 postmenopausal women submitted to surgery for genital prolapse grades I and II were examined. Patients were evaluated for FSH, estradiol, prolactin, glycemia, and serum TSH levels. For histological analysis, samples were stained with Masson’s trichrome and hematoxylin-eosin. Sexual function was assessed by the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Main Outcome Measures GRISS questionnaire, histological analysis, morphometric methods, Masson’s trichrome. Results The vaginal wall was thicker in the postmenopausal than premenopausal group (2.72 ± 0.72 mm and 2.16 ± 0.43, P = 0.01, and 2.63 ± 0.71 mm and 2.07 ± 0.49 mm, P = 0.01, for the anterior and posterior walls, respectively). These thicknesses seem to be due to the muscular layer, which was also thicker in the postmenopausal group (1.54 ± 0.44 and 1.09 ± 0.3 mm, P = 0.02, and 1.45 ± 0.47 and 1.07 ± 0.44 mm, P = 0.03, for the anterior and posterior wall, respectively). The vaginal epithelium was thinner in the middle segment than in the proximal one in the posterior wall (0.17 ± 0.07 mm, 0.15 ± 0.05 mm, 0.24 ± 0.09 mm, P = 0.02). There was no correlation between coital pain, vaginal wall thickness, and estradiol levels in either group. Conclusion The vaginal wall is thicker after menopause in women with genital prolapse. In this study, vaginal thickness and estrogen levels were not related to sexual dysfunction.

IntroductionAdrenocortical and renal cell carcinomas rarely invade the right atrium (RA). These neoplasms need surgical treatment, are very aggressive and have poor prognostic and surgical outcomes.Case seriesWe present a retrospective cohort of nine cases of RA invasion through the inferior vena cava (four adrenocortical carcinomas and five renal cell carcinomas). Over 13 years (2002-2014), nine patients were operated in collaboration with the team of urologists. Surgery was possible in all patients with different degrees of technical difficulty. All patients were operated considering the imaging examinations with the aid of CPB. In all reported cases (renal or suprarenal), the decision to use CPB with deep hypothermic circulatory arrest (DHCA) on surgical strategy was decided by the team of urological and cardiac surgeons.ConclusionData retrospectively collected from patients of public hospitals reaffirm: 1) Low incidence with small published series; 2) The selected cases did not represent the whole historical casuistry of the hospital, since they were selected after the adoption of electronic documentation; 3) Demographic data and references reported in the literature were presented as tables to avoid wordiness; 4) The series highlights the propensity to invade the venous system; 5) Possible surgical treatment with the aid of CPB in collaboration with the urology team; 6) CPB with DHCA is a safe and reliable option; 7) Poor prognosis with disappointing late results, even considering the adverse effects of CPB on cancer prognosis are expected but not confirmed.

Background Ovarian clear cell carcinomas (OCCCs) are rare, aggressive and chemoresistant tumors. Geographical and ethnic differences in the incidence of OCCC have been reported with a higher incidence in Asiatic countries. There is a paucity of information regarding OCCC in Latin America (LA) and other countries. Methods Here, we characterized two cohorts of 33 patients with OCCC from LA (24 from Brazil and 9 from Costa Rica) and a cohort of 27 patients from Spain. Genomic analysis was performed for 26 OCCC using the OncoScan platform. Tumors were classified according to their genomic landscapes into subgroups. Clinical parameters were related to the frequency of genomic aberrations. Results The median overall survival (OS) was not significantly different between the cohorts. Genomic landscapes were characterized by different homologous recombination deficiency (HRD) levels. No difference in the distribution of genomic landscapes profiles was detected between patients from the different cohorts. OCCCs with MYC-amplified tumors harboring a concomitant loss of a region in chromosome 13q12-q13 that includes the BRCA2 gene had the longest OS. In contrast, patients carrying a high number (> 30) of total copy number (CN) aberrations with no concomitant alterations in MYC and BRCA2 genes presented the shortest OS. Furthermore, amplification of the ASH1L gene was also associated with a shorter OS. Initial-stage OCCCs with early progression were characterized by gains in the JNK1 and MKL1 genes. Conclusions Our results provide new data from understudied OCCC populations and reveal new potential markers for OCCCs.

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INTRODUÇÃONeurofibromas são tumores benignos originados do tecido endoneural dos nervos periféricos. Histopatologicamente são formados por diferentes combinações de células de Schwann, fibroblastos e axônios (1)(2) . Clinicamente, eles podem-se apresentar ou como massas bem circunscritas, isoladas ou múltiplas, ou como lesões mais infiltrativas de limites imprecisos. Os neurofibromas não mostram predileção por faixa etária ou sexo (3) e podem aparecer em qualquer local, assim como no tecido ósseo (1) . Um outro tumor oriundo da mesma região e com características clínicas semelhantes é o neurilemoma, ou schwannoma (também chamado de neurinoma) (2) . O entendimento da anatomia dos nervos periféricos é essencial para a distinção desses dois tipos de tumores.A maioria dos nervos periféricos é composta por feixes de fibras nervosas, constituídos por um conjunto de axônios. São três as bainhas conjuntivas que entram na formação de um nervo: o epineuro, o perineuro e o endoneuro. O epineuro envolve o nervo como um todo e emite septos para seu interior. Estes septos envolvem os feixes de fibras nervosas constituindo o perineuro. No interior desses feixes, cada fibra nervosa, ou axônio, é envolvida por uma trama delicada de tecido conjuntivo, o endoneuro. Essa camada é formada, basicamente, por fibroblastos imersos numa matriz colá-gena. Na maioria dos nervos periféricos, os feixes de fibras são formados por axônios mielinizados e não mielinizados. A mielina é formada pelas células de Schwann. Embora todos os axônios dos nervos periféricos sejam envoltos por células de Schwann em apenas alguns há a formação de uma verdadeira bainha de mielina (4)(5) . Neurofibroma orbitário isolado e endotropia -Relato de caso e revisão da literaturaOs autores relatam um caso de neurofibroma orbitário, isolado, associado à endotropia do olho esquerdo, incomitante, de aparecimento lento e progressivo há 5 anos, sem referência à diplopia. O exame da sensorialidade mostrava acuidade visual normal em ambos os olhos e ausência de diplopia devido à supressão alternante. Exames de imagem da órbita (tomografia computadorizada e ressonância magnética) revelaram lesão alongada intracônica junto ao músculo reto lateral esquerdo. A paciente foi submetida à orbitotomia para exérese de massa intra-orbitária, sem procedimento específico para a correção do estrabismo, deixada para uma segunda oportunidade. Após a cirurgia, houve diminuição do ângulo do desvio, com manutenção do quadro supressivo. RELATOS DE CASOS